Post Natal Hellp Complications

[jwhite]

I delivered my first child 14 months ago. I was diagnosed with Hellp at around 37 weeks after suffering through symptoms such as severe itching, and edema for 6 weeks. Luckily the delivery went ok and my baby was healthy. However, 14 months later my liver enzymes are still elevated (fluctuating from slighly elevated to high), and I have numbness in parts of my feet, which occurred during pregnancy. I have seen a neurologist for the numbness and all tests were fine. I have been tested for every kind of ailment possible, had numerous ultrasounds, and a liver biospy with no explanation to my elevated liver enzymes. My doctors are all discounting these effects as being related to the hellp syndrome because they suggest that everything should clear up with delivery. However, I have read that if hellp is not caught in time that permament liver and central nervous system damage can occur. Does anyone have any information on the post natal complications of hellp syndrome? Any information would be highly appreciated!

[expert on call]

Recovery of both platelet and liver abnormalities from HELLP is usually rapid and complete, thus the case is surprising. Severe preeclampsia with HELLP has however, been rarely associated with liver infarction, and necrosis, that conceivably would lead to scarring. In addition, acute fatty liver of pregnancy can have HELLP like features, and histologic lesions resembling hepatitis have been described in that disorder. Also, the history of itching for six weeks before developing a preeclampsia-HELLP syndrome suggests the patient may have had another disease such as “benign cholestasis of pregnancy” (usually itching with but mild enzyme elevations, but it can be associated with jaundice and more severe enzyme abnormalities). This is a disease of late pregnancy. This disease, too, abates postpartum, but may be associated with gall stones. Of importance here, is that if laboratory abnormalities persist the patient might be managed by a competent gastroenterologist, preferably one with experience in hepatic diseases, and if a liver biopsy was performed it might be read by a pathologist or hepatologist experienced in reading these biopsies. In sum, the case is very atypical, but it sounds like the patient is being followed closely by her physicians.

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